There are so many positive aspects to aging – while it’s true some people become more crotchety and stubborn, most become wiser, more experienced, more forgiving and appreciative. But as our brains mature, so do our bodies, and certain health problems endemic to our chronological progression occur. That includes changes to our hearing, our mobility and our eyesight. As an example, more than 24.4 million Americans develop cataracts by age 40 and older. By age 75, approximately half of all Americans have cataracts.

A cataract is a clouding of the normally clear lens of our eye. For people who have cataracts, seeing through cloudy lenses is a bit like looking through a frosty or fogged-up window. Clouded vision caused by cataracts can make it more difficult to read, drive a car (especially at night), see the print on signs, watch television and movies and use our computers.

Most cataracts develop when aging or injury changes the tissue that makes up the eye’s lens. Normally, cataracts develop slowly and don’t disturb our eyesight early on. But with time, cataracts will eventually interfere with vision. At first, stronger lighting and eyeglasses can help us deal with cataracts. But if impaired vision interferes with usual activities, stronger prescriptions will no longer improve visual acuity, and cataract surgery may be required. Fortunately, the only real solution, cataract surgery, is generally a safe, effective procedure.

Some inherited genetic disorders that cause other health problems can increase our risk of cataracts. Cataracts can also be caused by other eye conditions, past eye surgery or medical conditions such as diabetes. Long-term use of steroid medications, too, can cause cataracts to develop.

How Does a Cataract Form?

The lens, where cataracts form, is positioned behind the colored part of our eye (iris). The lens focuses light that passes into our eye, producing clear, sharp images on the retina — the light-sensitive membrane in the eye that functions like the film in a camera.

As we age, the lenses in our eyes become less flexible, less transparent and thicker. Age-related and other medical conditions cause tissues within the lens to break down and clump together, clouding small areas within the lens.

As the cataract continues to develop, the clouding becomes denser and involves a bigger part of the lens. A cataract scatters and blocks the light as it passes through the lens, preventing a sharply defined image from reaching our retina. As a result, vision becomes blurred.

Cataracts generally develop in both eyes, but not evenly. The cataract in one eye may be more advanced than the other, causing a difference in vision between eyes.

Typical signs and symptoms of cataracts include:

Clouded, blurred or dim vision

Increasing difficulty with vision at night

Sensitivity to light and glare

Need for brighter light for reading and other activities

Seeing “halos” around lights

Frequent changes in eyeglass or contact lens prescription

Fading or yellowing of colors

Double vision in a single eye

At first, the cloudiness in vision caused by a cataract may affect only a small part of the eye’s lens and we may be unaware of any vision loss. As the cataract grows larger, it clouds more of our lens and distorts the light passing through the lens. This may lead to more noticeable symptoms.

Factors that increase the risk of cataracts include:

Increasing age

Diabetes

Excessive exposure to sunlight

Smoking

Obesity

High blood pressure

Previous eye injury or inflammation

Previous eye surgery

Prolonged use of corticosteroid medications

Drinking excessive amounts of alcohol

How to Minimize the Onset of Cataracts

No studies have proved how to prevent cataracts or slow the progression of cataracts. But doctors think several strategies may be helpful, including:

Have regular eye examinations.Eye examinations can help detect cataracts and other eye problems at their earliest stages. Ask your doctor how often you should have an eye examination.

Quit smoking.Ask your doctor for suggestions about how to stop smoking. Medications, counseling and other strategies are available to help.

Manage other health problems.Follow your treatment plan if you have diabetes or other medical conditions that can increase your risk of cataracts.

Choose a healthy diet that includes plenty of fruits and vegetables.Studies have shown that a healthy diet rich in vitamins and minerals was associated with a reduced risk of developing cataracts. Adding a variety of colorful fruits and vegetables to our diet ensures that we’re getting many vitamins and nutrients. Fruits and vegetables have many antioxidants, which help maintain the health of our eyes.

Wear sunglasses.Ultraviolet light from the sun may contribute to the development of cataracts. Wear sunglasses that block ultraviolet B (UVB) rays when outdoors.

Reduce alcohol use.Excessive alcohol use can increase the risk of cataracts.Top of Form

What Happens During Cataract Surgery?

Cataract surgery involves removing the clouded lens and replacing it with a clear artificial lens. The artificial lens, called an intraocular lens, is positioned in the same place as our natural lens. It remains a permanent part of our eye. For some people, other eye problems prohibit the use of an artificial lens. In these situations, once the cataract is removed, vision may be corrected with eyeglasses or contact lenses.

Cataract surgery is generally done on an outpatient basis, so there isn’t an overnight stay involved. During cataract surgery, the eye doctor uses local anesthetic to numb the area around the eye, but the patient usually stays awake during the procedure.

Cataract surgery is generally safe, but it carries a risk of infection and bleeding. Cataract surgery also increases the risk of retinal detachment.

After the procedure, patients have some discomfort for a few days. Healing generally occurs within eight weeks. If cataract surgery is required in both eyes, the doctor will schedule surgery to remove the cataract in the second eye after the patient has healed from the first surgery.

June is National Cataract Awareness Month, and since this age-related disorder afflicts many Americans, it pays to learn cataract warning signs. For most people who have cataract surgery, the results are startling – significantly improved vision, a return to all activities, and for many, the elimination of eyeglasses or the need to wear them for either distance or reading only. Check in with your eye doctor at least annually, and know that even though it may be disconcerting, corrective measures are readily available and highly successful.

We’re not even through the sneezy, sniffly, coughing and wheezing allergy months and now we’re faced with the itching, biting and scratching bug season. It isn’t fair – but that’s spring in Connecticut. Unfortunately, the number of people infected with diseases transmitted by ticks, mosquitos and fleas has more than tripled over the past few years, and the prognosis for 2019 doesn’t appear any better.

Of great concern is the possibility of contracting Lyme disease caused by the bacterium Borrelia burgdorferi. It is transmitted to humans through the bite of infected blacklegged ticks, which are common to Connecticut. Typical symptoms include fever, headache, fatigue, and a characteristic skin rash called erythema migrans. If left untreated, infection can spread to joints, the heart, and the nervous system.

Lyme disease is diagnosed based on symptoms, physical findings (such as a rash), and the possibility of exposure to infected ticks. Most cases of Lyme disease can be treated successfully with a few weeks of antibiotics. Steps to prevent Lyme disease include using insect repellent, removing ticks promptly, applying pesticides, and reducing tick habitat. The ticks that transmit Lyme disease can occasionally transmit other tick-borne diseases as well.

First recognized in the Lyme, Connecticut area in 1975, the State Department of Public Health (DPH) reports about 3,000 cases annually to the Centers for Disease Control and Prevention (CDC). But the CDC estimates that there are approximately 10 times more people diagnosed with Lyme disease than the yearly reported number. Using the CDC estimate, approximately 30,000 people are afflicted with Lyme disease each year in Connecticut alone. Nationally, that number is thought to be close to 300,000 cases annually.

Bacteria cause most tickborne diseases in the United States, with Lyme disease representing the majority (82 percent) of reported cases. Borrelia burgdorferi is carried by hard-bodied ticks that then feed on smaller mammals, such as white-footed mice, and larger animals, such as white-tailed deer. Scientists believe that increased seasonal warming, caused by climate change, is a contributing factor to the proliferation of these pests.

Although there are likely many additional factors contributing to increased Lyme disease incidence in the United States, greater tick densities and their expanding geographical range have played a key role. Although most cases of Lyme disease are successfully treated with antibiotics, 10 to 20 percent of patients report lingering symptoms after effective antimicrobial therapy.

Tick Season is Here

Tickborne virus infections are also increasing and can cause serious illness and death. Another invasive and disease-carrying tick, the Asian Longhorned tick, has been discovered in Connecticut. Fortunately, it preys primarily on livestock and wildlife and isn’t yet considered a threat to humans, experts say. The newly arrived pest was found by scientists at Western Connecticut State University last summer during a monitoring project in Fairfield County. It had previously been identified in New York, and across the eastern and southern United States over the past few decades. Found in grassy and wooded areas, researchers suggest using the same precautions against this species as for native ticks, including protective clothing, insect repellents and close checking of skin after being in the outdoors where ticks are present.

In addition to tick concerns, certain types of mosquitos carry diseases such as West Nile Virus (WNV), which has been present in Connecticut since 1999 in mosquitoes, horses, wild birds and people. Most people who are infected with WNV have no symptoms or may experience mild illness such as a fever and headache before fully recovering. In some individuals, particularly persons over 50 years of age, West Nile virus can cause serious illness, including encephalitis (inflammation of the brain) or meningitis (inflammation of the membranes covering the brain and spinal cord). Symptoms range from a slight fever, headache, rash, swollen lymph nodes and nausea to the rapid onset of a severe headache, high fever, stiff neck, disorientation, muscle weakness, and coma. West Nile virus infection can lead to death in three percent to 15 percent of persons with severe forms of the illness.

Health professionals also are keeping a vigilant watch for the Zika virus, which is spread mostly by the bite of infected Aedes species mosquitos, which bite during the day and night. Zika can be passed from a pregnant woman to her fetus, and infection during pregnancy can cause certain birth defects. There is no vaccine or medicine for Zika, and while local mosquito-borne Zika virus transmission has been reported primarily in tropical climates like Florida, Connecticut experienced a few dozen cases in 2018.

Unless you plan to spend the summer indoors, you’re likely to come in contact with some of these annoying pests. You can improve your odds of not getting bitten by wearing protective clothing, headgear and socks, using insect repellants and citronella products, minimizing use of cologne and perfume when planning outdoor activities, avoiding swampy areas, and moving the party indoors during the height of bite time. You also can spray clothes with repellent containing permethrin, and use a repellant like DEET on your skin.

Protecting Against Ticks and Mosquitoes

While it is a good idea to take preventive measures against ticks and mosquitoes year-round, be extra vigilant in warmer months (April through September) when ticks are most active. In summer, when out hiking, biking, camping, and spending time in and around grass and woods, there are several steps you can take to limit bites from ticks, mosquitoes and other disease-bearing insects:

Avoid direct contact with ticks and mosquitoes as possible. If you can, avoid wooded and bushy areas with high grass and leaf litter. When hiking, picnicking or walking, try to remain in the center of trails.

Use repellents that contain 20 percent or more DEET (N, N-diethyl-m-toluamide) on the exposed skin for protection that lasts up to several hours. Always follow product instructions. Parents should apply this product to their children, avoiding hands, eyes, and mouth.

Use products that contain permethrin on clothing. Treat clothing and gear, such as boots, pants, socks and tents. It remains protective through several washings. Pre-treated clothing is available and remains protective for up to 70 washings.

If you’re using other repellents, go to the Environmental Protection Agency (EPA) website for safety information.

Ridding Ourselves of Ticks

Ticks embedded in your skin can be gross, but painless. The best bet is to keep them at bay. But if they do find you, here are tips for dealing with them easily and effectively:

Bathe or shower as soon as possible after coming indoors (preferably within two hours) to wash off and more easily find ticks that are crawling on you.

Conduct a full-body tick check using a hand-held or full-length mirror to view all parts of your body upon return from tick-infested areas. Parents should check their children for ticks under the arms, in and around the ears, inside the belly button, behind the knees, between the legs, around the waist, and especially in their hair.

Examine gear and pets. Ticks can ride into the home on clothing and pets, then attach to a person later, so carefully examine pets, coats, and day packs. Tumble clothes in a dryer on high heat for an hour to kill remaining ticks.

Consult your doctor or a nurse (or internet sources) to determine the best method for removing the tick; it’s important to remove the entire tick, or it can leave parts embedded in your skin.

Should you or a family member develop a bulls-eye-type red rash near the bite site, or exhibit other side effects such as a fever, lethargy or extreme exhaustion, consult your doctor. You may need to be tested for Lyme disease.

If you know you have an allergy to one or more biting insects, you should always carry an epi-pen or other backup medication in case you’re stung or bitten, and seek immediate medical attention. For the rest of us, most bites or stings leave a mark and cause some swelling and irritation. Ice or a cool compress applied directly to the site can bring relief, as can topical salves, ointments or sprays sold over the counter. If the area around the bite continues to expand or becomes blistery and weepy, you have to get checked for a possible infection.

Embracing change isn’t always easy, especially those transformations that affect or challenge our health. But, like it or not, chemical, biological and physiological changes take place as we age, and understanding these processes helps us maintain our quality of life and even prolong our years on earth.

As we grow older, new bone is made and old bone is broken down. When we’re young, our body makes new bone faster than it breaks down old bone, increasing bone mass. Most people reach their peak bone mass around age 30. After that, we lose more bone mass than we gain.

Osteoporosis, which affects more than 53 million Americans, is a condition that causes bones to become weak and brittle, making them easier to fracture or break. Our likelihood of developing osteoporosis depends on how much bone mass we attain by the time we reach age 30 and how rapidly we lose it after that. The higher our peak bone mass, the less likely we are to develop osteoporosis as we age.

Osteoporosis affects the structure and strength of bones and makes fractures more likely, especially in the spine, hip and wrists. It is most common among females after menopause, but smoking and poor diet increase the risk for women and men. There are often no clear outward symptoms, but weakening of the spine may lead to a stoop, and there may be bone pain.

We can build strong bones by getting enough calcium and weight-bearing physical activity during our teen years and into our early 20s, when bones are growing the fastest. Young people in this age group have calcium needs that they can’t make up for later in life. In the years of peak skeletal growth, teenagers build more than 25 percent of adult bone. By the time teens finish their growth spurts around age 18, 90 percent of their adult bone mass is established.

It’s important to understand that our bodies continually remove and replace small amounts of calcium from our bones, so stemming the loss of calcium is important. After our late teens, however, we can’t add more calcium to bones, but can try to maintain what is already stored to help our bones stay healthy.

Keeping Our Bones Healthy and Strong

Calcium is found in a variety of foods. Low-fat and fat-free milk and other dairy products are great sources of calcium. Teens can get most of their daily calcium from three cups of low-fat or fat-free milk, but they also need additional servings of calcium to get the 1,300 mg necessary for strong bones.

Other good sources of calcium include dark green, leafy vegetables such as spinach, broccoli and bok choy. Other sources of calcium include almonds, broccoli, kale, canned salmon with bones, sardines and soy products such as tofu.

There also are foods with calcium added, such as calcium-fortified tofu, orange juice, soy beverages, and breakfast cereals or breads. Adults or kids who can’t process lactose also can take calcium supplements, but should check with their physician to ensure compatibility with other medicines or conditions.

When muscles push and tug against bones during physical activity, bones and muscles become stronger. Weight-bearing exercises, such as walking, jogging, tennis and climbing stairs can help build strong bones and slow bone loss. So, exercise as well as proper nutrition play vital roles in helping us build and maintain healthy bones at any age.

A number of additional factors can affect bone health. For example:

Tobacco and alcohol use.Research suggests that tobacco use contributes to weak bones. Similarly, having more than two alcoholic drinks a day increases the risk of osteoporosis, possibly because alcohol can interfere with the body’s ability to absorb calcium.

Gender, size and age.You’re at greater risk of osteoporosis if you’re a woman, because women have less bone tissue than do men. You’re also at risk if you’re extremely thin (with a body mass index of 19 or less) or have a small body frame, because you may have less bone mass to draw from as you age. Also, our bones become thinner and weaker as we age.

Race and family history.You’re at greatest risk of osteoporosis if you’re white or of Asian descent. In addition, having a parent or sibling who has osteoporosis puts you at greater risk — especially if you also have a family history of fractures.

Hormone levels.Too much thyroid hormone can cause bone loss. In women, bone loss increases dramatically at menopause due to dropping estrogen levels. Prolonged absence of menstruation before menopause also increases the risk of osteoporosis. In men, low testosterone levels can cause a loss of bone mass.

Eating disorders and other conditions.People who have anorexia or bulimia are at risk of bone loss. In addition, stomach surgery (gastrectomy), weight-loss surgery and conditions such as Crohn’s disease, celiac disease and Cushing’s disease can affect our body’s ability to absorb calcium.

Certain medications.Long-term use of corticosteroid medications, such as prednisone, cortisone, prednisolone and dexamethasone, are damaging to bone. Other drugs that may increase the risk of osteoporosis include aromatase inhibitors to treat breast cancer, selective serotonin reuptake inhibitors, methotrexate, some anti-seizure medications and proton pump inhibitors.

If you find it difficult to get enough calcium from your diet, ask your doctor about supplements. Pay attention to foods with vitamin D, include physical activity in your daily routine, and avoid smoking tobacco products or drinking too much alcohol. We can’t get back what we’ve lost when it comes to calcium, but we can do much to minimize future loss and protect our bones and overall wellness.

After an inactive winter it’s easy to strain or hurt ourselves the first time we’re working outdoors, clearing or preparing a garden, swinging a golf club or baseball bat, moving outdoor furniture or simply doing anything physical. There are a number of tips we can follow to prevent or limit muscle strain, aches and injuries, including stretching before and after physical activities, remaining properly hydrated, getting enough sleep, eating well and knowing our own limitations.

One of the keys to remaining injury-free before work or working out is to make sure to stretch properly and bend and lift carefully to avoid back, knee and shoulder injuries. Always stretch before, and when possible, after working or exercising.

Proper stretching loosens up tight muscles and makes us more limber. When stretching, focus on the big muscles first. The quadriceps and hamstrings in our thighs are generally the largest muscles of the body and deserve special attention, particularly because they play a key supporting role for our backs. That means stretching the back, front, and inner and outer thigh. Then continue to work the other muscle groups, from your neck to your toes, tightening and loosening each as you move down your body.

Besides warming up, when gardening, doing yard work or taxing ourselves physically, it’s important to use proper techniques for bending and lifting. Simple tips include keeping objects close to our bodies when lifting, and maintaining the natural curves of our spine as we work. It’s useful to bend our knees and squat or kneel to get to ground level instead of bending over. And when kneeling, be mindful of position: try kneeling with one knee on the ground and the other up, and periodically switch knees to alleviate pressure. Also try to avoid sudden twisting or reaching motions, keeping movements smooth, and adjust posture frequently to reduce the risk of repetitive-motion injuries.

Another trick for staying loose and avoiding aches and pains is to apply heat before and after a workout. Heat prior to working out can minimize muscle strain. After a workout, muscles and joints are potentially dehydrated and, because they are weakened, are not as stable as when they have been resting. Applying a heating pad or wrap for 10 – 15 minutes while seated or lying down after a workout session or strenuous activity like spring cleaning can help muscles calm down and return to their normal state without seizing up.

Proper Bending Is Key to Avoiding Injuries

Always be sure to bend at the hip, not the lower back. Most people believe bending their knees will ensure a safe lift, but this form alone can still lead to a back injury. The most important tip is to bend the hips and keep the upper body upright as much as possible, pointing forward.

Keeping the chest forward also is important. When the chest is kept forward and the body is bent at the hips, the back is kept straight and back injury can be avoided. The back muscles will then be used most effectively for maintaining good posture, as they are designed to do. The knees will bend automatically so the muscles of the legs and hips will produce the power for lifting correctly.

Twisting, repetitive lifting or hefting strenuous amounts of weight is another dangerous mistake that can lead to back or shoulder injury. The shoulder is one of the most complex joints in our body; comprising more than 30 muscles and six major ligaments, it can move and articulate into more than 1,500 different positions. Our shoulders should be kept in line with the hips to avoid twisting movement. For changing directions, move the hips first so the shoulders will move in unison. When moving the shoulders first, the hips tend to lag behind creating the dangerous twisting that can cause back injury, especially to the joints in the back and pelvis.

Here are some additional tips for avoiding injuries and remaining healthy, especially as the spring draws us out of hibernation and into a full range of outdoor and indoor activities:

Stay hydrated. This is good advice anytime, but especially when engaged in sports or working outdoors. Dehydrated muscles and tendons are less flexible and less resilient. If you’re a coffee drinker, reduce your risk of muscle strain by drinking more water than coffee, and avoid excessive alcohol, another cause of dehydration.

Avoid smoking. In addition to its other downsides, nicotine impairs the healing process for tendons and muscles.

Vary activities: Mix it up to prevent muscle imbalance. If repeating the same overhead motion, shoulder muscles will get overworked and others will decondition; this can throw off the shoulder’s balance, resulting in tendon damage.

Use proper form when lifting and carrying heavy items. Keep an upright position to help protect the back. And if you’re doing overhead work, use a ladder or step stool to put the work at eye level and reduce stress on the shoulders.

Eat well: Without the nutrients our muscles need to stay healthy and to heal if they become strained, we put ourselves at constant risk. Avoid sweets, fried foods and excessive salt, and focus on a broad mix of fruits, vegetables and grains, as well as fish and other proteins.

Preventing injuries and staying healthy is a day-by-day activity – if you hurt yourself right out of the gate in the spring, it may take months to heal . . . and before you know it, winter will be here again! So, remember to stretch before and after physical activity to help your muscles relax and rebound more quickly, and take care of your body!

Good oral health is a critical aspect of overall health and wellness, yet many Americans take it for granted. While properly brushing and flossing teeth is an important prevention component, along with regular dental visits, the rise of oral cancers is reaching serious proportions and, sadly, the causes of many oral cancers are largely preventable.

The prevalence of oral cancer in the United States is typically associated with four behaviors that, if avoided or minimized, could have a significant impact on reducing incidences. They include the use of all tobacco products – including cigarettes, snuff, chewing tobacco and vaping; alcohol consumption; oral sex leading to acquiring sexually transmitted diseases, especially involving Human papilloma virus (HPV); and excessive sun exposure.

Oral health is not only important to our appearance and sense of well-being, but also to our overall health. Cavities and gum disease may contribute to serious conditions such as diabetes, heart and respiratory disease, and untreated cavities can be painful and lead to serious infections. Poor oral health has been linked to sleeping problems, as well as behavioral and developmental problems in children. It can also affect our ability to chew and digest food properly.

Nearly one-third of all adults in the United States have untreated tooth decay. One in seven adults aged 35 to 44 years has gum disease; this increases to one in every four adults aged 65 years and older. Oral cancers are most common in older adults, particularly those over 55 years who smoke and are heavy drinkers, but those statistics are changing in younger people who indulge in excessive smoking, use of smokeless tobacco products, vaping, alcohol consumption and oral sex.

Reducing Plaque Buildup

Plaque is a sticky, colorless film of bacteria that constantly builds up, thickens and hardens on the teeth. If it is not removed by daily brushing and flossing, this plaque can harden into tartar and may contribute to infections in the gums. Left untreated, gum disease can lead to the loss of teeth and an increased risk of more serious illnesses.

The bacteria in plaque can travel from the mouth to the lungs, causing infection or aggravating existing lung conditions. It creates risks for heart patients, too, as it can travel through the bloodstream and get lodged in narrow arteries, contributing to heart attacks. There also is a link between diabetes and gum disease.

Everyone should brush their teeth at least twice a day, preferably within 30 minutes of eating. When bacteria in plaque come into contact with food, they produce acids. These acids lead to cavities. Flossing is critical, as well, and does about 40 percent of the work required to remove plaque from the hard-to-reach spaces between our teeth.

Proper nutrition plays a key role in oral health, as well. Food high in processed sugars and fats are not good for body or teeth – they contribute to weight gain, diabetes, heart disease, hypertension and even certain types of cancers. A well-rounded, vitamin-rich, balanced diet high in fiber and filled with vegetables, fruits and plenty of water will help maintain a healthy mouth, as well as a healthier body. And regular visits to the dentist are essential for screening for cavities, infections and other abnormalities that can be reflective of heart health and other diseases.

Preventing Oral Cancer

Signs and symptoms of mouth cancer may include:

A sore that doesn’t heal

A sore that bleeds

A growth, lump or thickening of the skin or lining of the mouth

Loose teeth

Poorly fitting dentures

Tongue pain

Jaw pain or stiffness

Difficult or painful chewing

Difficult or painful swallowing

Sore throat

Tobacco and alcohol use are among the strongest risk factors for oral cavity and oropharyngeal cancers. When tobacco and alcohol damage the cells lining the mouth and throat, the cells in this layer must grow more rapidly to repair this damage. The more often cells need to divide, the more chances there are for them to make mistakes when copying their DNA, which may increase their chances of becoming cancerous.

Many of the chemicals found in tobacco can damage DNA directly. Research has shown that alcohol helps many DNA-damaging chemicals get into cells more easily. This may be why the combination of tobacco and alcohol damages DNA far more than tobacco alone. This damage can cause certain genes (for example, those in charge of starting or stopping cell growth) to malfunction. Abnormal cells can begin to build up, forming a tumor. With additional damage, the cells may begin to spread into nearby tissue and to distant organs.

Oral cancer may occur on the floor of the mouth, the lining of the cheek, the gingiva (gums), the lips or the palate (roof of the mouth). Early-stage symptoms can include persistent red or white patches, a non-healing ulcer, progressive swelling or enlargement, unusual surface changes, sudden tooth mobility without apparent cause, unusual oral bleeding or prolonged hoarseness.

Smokers are many times more likely than non-smokers to develop these cancers. Tobacco smoke from cigarettes, cigars, or pipes can cause cancers anywhere in the mouth or throat, as well as causing cancers of the larynx (voice box), lungs, esophagus, kidneys, bladder, and several other organs.

Oral tobacco products (snuff or chewing tobacco) are linked with cancers of the cheek, gums, and inner surface of the lips. Using oral tobacco products for a long time poses an especially high risk. These products also cause gum disease, destruction of the bone sockets around teeth, and tooth loss. It is also important for people who have been treated for oral cavity or oropharyngeal cancer to give up any oral tobacco products.

Most brands of e-cigarettes on the market contain high amounts of nicotine, typically more than found in regular cigarettes. E-cigs or vaping liquids also contain formaldehyde, which is a chemical used in some building materials, as well as in the process of embalming dead bodies. Formaldehyde is a known cancer-causing agent, and repeated exposure to it can result in precancerous changes in the lining of the mouth that can be the beginning stages of oral cancer. And the various flavorings used to make e-Cigarettes taste pleasant can also contain cancer-causing compounds, as well as lung irritants.

HPV and Oral Cancer

Human papilloma virus (HPV) is a group of more than 150 types of viruses. They are called papilloma viruses because some of them cause a type of growth called a papilloma. Papillomas are not cancers, and are more commonly called warts. Infection with certain types of HPV can also cause some forms of cancer, including cancers of the penis, cervix, vulva, vagina, anus, and throat. Other types of HPV cause warts in different parts of the body.

HPV can be passed from one person to another during skin-to-skin contact. One way HPV is spread is through sex, including vaginal and anal intercourse and even oral sex.

Most people with HPV infections of the mouth and throat have no symptoms, and only a small percentage develop oropharyngeal cancer. Oral HPV infection is more common in men than in women. The risk increases with the number of sexual partners a person has, and smoking also increases the risk of oral HPV infection.

At this time the U.S. Food and Drug Administration has not approved a test for HPV infection of the mouth and throat. Cancers of the oral cavity and oropharynx usually take many years to develop; most patients with these cancers are older than 55 when the cancers are first found. But this is changing as HPV-linked cancers become more common. People with cancers linked to HPV infection tend to be younger.

There’s no proven way to prevent mouth cancer. However, we can reduce our risk of mouth cancer if we avoid or limit tobacco products, consume alcohol moderately, avoid excessive exposure to the sun (when outdoors, use sunscreen and lip balms with UV protection), eat a wide variety of fruit and vegetables, and visit the dentist regularly!

Are you a good patient? Seriously, have you given much thought to this important topic? Patient safety isn’t just about limiting medical errors, preventing infections in the hospital or about reducing missed diagnoses . . . it’s about engagement, participation and anticipation to help ensure better understanding and results.

Our own behavior, choices and responsibility play key roles in health and wellness, yet many patients fail to understand, or worse, disregard or ignore their own duties when it comes to keeping themselves healthy.

Good communication and planning are critical to our overall health and wellness picture. It’s amazing how few people think about the basics, such as having a healthcare proxy, keeping emergency contact information handy, always knowing what specific medications you take, or having someone accompany you to a medical appointment when discussing surgery, care, preventative steps or medical and pharmaceutical compliance.

These are basic, yet vital steps. When you go to see a new doctor or specialist, he or she will always ask about medications you are taking, previous surgeries, allergies, immunization records, family history and symptoms. That’s a lot to remember when you’re anxious, worried or in pain. And if it’s an emergency or you’re not conscious or fully aware, that important information will be filled in when possible, instead of being available upfront when it may count the most.

If you haven’t already, create those lists for yourself, and give copies to someone you trust, like a partner, spouse, child, parent or friend. When you get to see them next, make sure to update each of your doctors when one of them changes or adds a prescription, or if you’ve had a medical procedure, illness or surgery.

The Importance of Asking Questions

We’re often more likely to ask tough, well-researched and straightforward questions when we buy a car, washing machine or refrigerator than when we’re sitting with a physician, nurse or medical technician. That’s human – we don’t want them to think we don’t trust them or are questioning their judgment. Yet knowledge is essential for ensuring good medical outcomes, and for our emotional health.

Prior to your appointment, write down any relevant questions, no matter how obscure or embarrassing they may seem. Most medical professionals want your questions – the more you know, the better you can help assist in your own preparation and recovery.

This can include steps you need to take prior to a visit or procedure, what to eat or drink, when to take your medications, how to apply bandages and medicines, frequency and potential side effects or expected results.

It’s always good to consider bringing a friend or family member with you to an appointment, especially if the topic is complex or you’re concerned about remembering all the details. This also helps when struggling with cultural or language differences, or when facing a physician or medical professional of another gender, nationality or age. Anything that makes you uncomfortable may interfere with your asking probing, relevant questions, and playing a guessing game later on is not a wise move.

Why Create a Healthcare Proxy?

Everyone needs a health care proxy, not just the elderly. Anybody can be in a situation where they’re temporarily unable to speak for themselves. By naming someone in a healthcare proxy to speak for you, and by informing them of your wishes, you relieve the potential burden on others.

A health care proxy is a legal document that lists who you have chosen to make medical decisions for you if you are not able to speak directly to the physicians caring for you.

For example, if you are in a car accident and need an emergency surgery, the doctors are going to want someone to sign a form giving permission for the surgery. If you can’t give permission because you’re unconscious, they want a family member or the person listed in the healthcare proxy to give permission.

A healthcare proxy is important to have, even if you have immediate family members nearby. Sometimes decisions need to be made quickly, and if several family members are weighing in, it could delay care.

When creating your healthcare proxy, consider these steps:

Select someone who is willing and able to make decisions about your health. Some people are not natural decision makers, so that’s something to consider. Think about family dynamics, and who could make an effective decision.

Let the person know that they are listed in your healthcare proxy.

Give the person named in your healthcare proxy as much information as you can about your medical wishes.

A healthcare proxy form is easy to fill out. You will need to have two witnesses sign it, not including you or the person you have appointed. You can have the paperwork prepared by an attorney, or download one online. Many physician’s offices have blank healthcare proxies available, and typically their office staff can provide witnesses.

Once you’ve filled out the form, give one to your doctor and one to the person named in your healthcare proxy, and keep one in your house. You can change the designated person at any time, just like you would change a will. You also can decide to list an alternate person on the form, just in case the primary person can’t make the decision or is unreachable when needed.

The proxy document gives the person you designate the authority to make medical decisions on your behalf, but you are still responsible for explaining your medical wishes to them before an incident occurs. The document does not outline any specific medical action.

Taken together, these proactive healthcare steps are smart, insightful and extremely valuable. Being prepared for any medical occurrence, complying with medical direction and guidance, and ensuring that you take your medications exactly as prescribed make you a good medical consumer and supportive patient. That is our own responsibility and privilege, and a smart, healthy choice.

Our kidneys are workaholics. Seriously. When they report to work normally, wastes and water are routed to our bladders and flushed away as urine. If they start sloughing off, harmful waste including toxins and extra water build up in our blood.

Fortunately, we have two kidneys, each containing about a million tiny filters that process approximately 40 gallons of fluid daily. Our kidneys also produce several hormones which help control blood pressure, make red blood cells and activate vitamin D, which helps keep our bones strong.

We all lose a little of our kidney function as we age. People can even survive with just one kidney. But when kidney function drops due to illness or an underlying kidney disease, falling hormone production, as well as excess water and toxic waste build up in our bloodstream, leading to dangerous complications. About one in 10 adults – close to 20 million Americans – suffer from kidney damage, and millions more are at risk.

There are different types of kidney disease. Most strike both kidneys at the same time, harming those small filters—called nephrons—and reducing their ability to function properly. When damage to nephrons happens quickly, often because of injury or poisoning, it’s known as acute kidney injury. It’s more common, though, for nephrons to worsen slowly and silently for years or even decades. This is known as chronic kidney disease.

This can occur in a person with normal kidneys or in someone who already has kidney problems.

Anyone can develop kidney disease, regardless of age or race. Family history is a marker, but there are other causes and catalysts. March is National Kidney Month, and a good opportunity to learn about kidney health and to think about improving diets to prevent or mitigate kidney damage and related potential consequences including diabetes, high-blood pressure, and cardiovascular disease.

Warning signs of kidney disease may include general fatigue and weakness, with nausea, vomiting and itching. For people with acute kidney injury or severe kidney disease, dialysis – a process where a machine cleanses our blood – may be necessary to restore normal kidney function or sustain us. In cases where the kidney stops functioning or is permanently damaged, a kidney transplant may be the only viable option.

Early kidney disease has no signs or symptoms. Without diagnostic testing, we may not feel any different until our kidney disease is very advanced. Blood and urine tests are the only way to know if we have kidney disease. A blood test checks our glomerular filtration rate (GFR), which tells how well our kidneys are filtering. A urine test checks for protein in our urine.

The sooner we know we may have kidney disease, the sooner we can get treatment to help delay or prevent kidney failure. Treatment may include taking medicines called ACE inhibitors or ARBs to manage high blood pressure and keep our kidneys healthier longer. Treating kidney disease may also help prevent heart disease.

Limiting or Preventing Kidney Disease

We can take many steps to avoid or delay reaching the point of kidney failure. The best preventative step is to control our blood pressure. A healthy lifestyle, including physical activity and a heart-healthy diet can help to normalize blood pressure and also slow kidney disease.

What we eat and drink can help prevent or slow down chronic kidney disease. Some foods are better for our kidneys than others. Cooking and preparing our food from scratch can help us eat healthier.

The first options for eating right involve choosing and preparing foods with less salt and sodium. To help control blood pressure, our diet should contain less than 1,500 milligrams of sodium each day.

Here are five simple steps for healthier eating and for maintaining healthy kidneys:

Buy fresh food more often. Sodium (a part of salt) is added to many packaged foods. Helpful tips include

Use spices, herbs, and sodium-free seasonings in place of salt

Check the Nutrition Facts label on food packages for sodium — Daily Value of 20 percent or more means the food is high in sodium

Try lower-sodium versions of frozen dinners and other convenience foods

Rinse canned vegetables, beans, meats, and fish with water before eating

Eat the right amount and the right types of protein. To help protect our kidneys, eat small portions of higher-protein foods. Protein is found in foods from plants and animals. Consider talking to a physician, nutritionist or dietitian about how to choose the right combination for you. Animal-protein foods include chicken, fish, meat, eggs and dairy. Plant-protein foods include beans, nuts and grains.

Choose foods that are heart healthy. To help keep fat from building up in our blood vessels, heart, and kidneys, grill, broil, bake, roast, or stir-fry foods, instead of deep frying. Cook with nonstick cooking spray or a small amount of olive oil instead of butter. And trim fat from meat and remove skin from poultry before eating. Heart-healthy foods include:

Lean cuts of meat, like loin or round

Poultry without the skin

Fish

Beans

Vegetables

Fruits

Low-fat milk, yogurt, cheese

Choose foods with less phosphorus. Phosphorus helpsprotect our bones and blood vessels, but too much isn’t good for us. Many packaged foods have added phosphorus. Look for phosphorus — or for words with “PHOS” — on ingredient labels. Deli meats and some fresh meat and poultry can have added phosphorus. Ask your butcher to help pick fresh meats without added phosphorus.

Foods lower in phosphorus include:

Fresh fruits and vegetables

Breads, pasta, rice

Rice milk (not enriched)

Corn and rice cereals

Light-colored sodas/pop

Foods higher in phosphorus include:

Meat, poultry, fish

Bran cereals and oatmeal

Dairy foods

Beans, lentils, nuts

Colas

Choose foods that have the right amount of potassium. Potassiumhelps our nerves and muscles work the right way. Salt substitutes can be very high in potassium, so it’s important to find a balance, since too much salt isn’t good for us, either. Read the ingredient label, and check with your provider about using salt substitutes.

Foods lower in potassium include:

Apples, peaches

Carrots, green beans

White bread and pasta

White rice

Rice milk (not enriched)

Cooked rice and wheat cereals, grits

Foods higher in potassium include:

Oranges, bananas

Potatoes, tomatoes

Brown and wild rice

Bran cereals

Dairy foods

Whole wheat bread and pasta

Beans and nuts

If genetics are on our side, we eat properly and exercise regularly, kidney disease doesn’t have to be a problem. Speak with your physician about maintaining your kidneys, and take these simple steps to ensure good kidney health.

People with chronic health conditions can benefit from specialized healthcare outreach and self-management programs in place at CBIA’s health benefits partners, ConnectiCare and Harvard Pilgrim Health Care. These programs help patients manage their conditions more effectively, with the goal of enhancing patient knowledge about specific diseases, encouraging compliance, preventing painful or dangerous complications as much as possible, and mitigating flareups when they occur.

ConnectiCare’s Touchpoints Program offers options to help members manage specific conditions including:

BREATHE – Asthma: for all members with asthma.

BREATHE – COPD: for members with chronic obstructive pulmonary disease (COPD), which includes chronic bronchitis and emphysema.

DiabetiCare – for adult members with diabetes.

HeartCare – CAD: for members with coronary artery disease.

HeartCare – HF: for members with heart failure.

Birth Expectations — for pregnant members with a history of a previous pre-term delivery or of carrying more than one baby.

Additionally, they offer a Kidney Case Management Program designed to help ConnectiCare members and their families manage kidney disease. A registered nurse with specialized training calls members to provide guidance and support and to monitor health conditions and complications that are commonly related to kidney disease.

Harvard Pilgrim takes a comprehensive approach to disease management, focusing on patient-centered care that coordinates resources across the health care delivery system and throughout the life cycle of a disease. Harvard Pilgrim’s disease management programs include a range of components specifically designed to reinforce clinicians’ treatment plans. These include:

Clinical practice guidelines for effective care

Patient identification and outreach

Patient education in managing their condition in order to reduce adverse outcomes and maximize quality of life.

These programs assist patients by helping them better understand their condition, giving them useful and timely information about their disease, and providing them with assistance from clinical health educators, nurses and pharmacists who can help them manage their disease.

If you think you qualify for a disease management program, or have other questions, contact your health benefits provider directly using the customer service number on your member identification card.

On the surface, talking about how to shovel and dress properly for cold-weather work, chores and play seems unnecessary – after all, we’re grownups and it’s not our first winter rodeo. However, it’s amazing how many millions of Americans end up in emergency rooms across the country every year suffering from show-shoveling-related back and shoulder injuries, frost bite or hypothermia.

While winter drives many people indoors to weather the deep freeze and shorter days, the season also abounds in natural beauty best appreciated while outside walking or hiking, sledding, skiing, snowmobiling, ice skating, ice fishing, working in the yard, or whatever floats your toboggan. And of course, there are those pesky winter storms and cleaning up the driveway, decks and sidewalks.

When it comes to winter comfort, health and safety, there are a few basic rules always in vogue: dress appropriately, know our limitations, and use common sense. No matter the recreational activity, work or task, take appropriate measures to protect yourself. That includes dressing for the weather, making sure we’re properly hydrated, wearing sunscreen, and always respecting Mother Nature.

Dress for Comfort and Safety

Dressing in layers and wearing the right types of materials are critical for keeping ourselves warm in the cold weather. But when planning our outdoor wardrobe, moisture management is also an important consideration. To keep the body warm during high-energy activities, clothing should transport moisture away from the skin to the outer surface of the fabric where it can evaporate. Also, look for garments made from the new stretch fabrics for better fit and performance.

Cotton is a poor choice for insulation, because it absorbs moisture and loses any insulating value when it gets wet. Instead, moisture-wicking synthetics, which move moisture away from the skin and stay light, are the best choice for working outdoors or for active winter sports like skiing, snowboarding, hiking or climbing. Not only do synthetic fabrics wick moisture away from the skin, they dry quickly and help keep us warm in the process.

The next layer should be a lightweight stretchy insulator, such as a breathable fleece sweater or vest. The final part of our cold-weather wear should be a lightweight and versatile shell jacket. Fabrics like three-layer Gore-Tex allow companies to create shells that are ultra-lightweight while remaining waterproof, windproof, and breathable. For aerobic activities, a shell’s ventilating features are particularly important. Look for underarm zippers, venting pockets, and back flaps.

Always bring a hat and gloves, regardless of the weather or activity level. Proper foot protection is critical, as well – wear insulated and water-proof shoes or boots, and synthetic socks that won’t absorb sweat, or layers of socks for wicking and warmth. As with the rest of our clothing, synthetic materials work best for protecting us against the extremes. Look for fleece hats made with breathable fabric, gloves and mittens layered with Gore-Tex and fleece, and socks made of synthetic, moisture-wicking materials.

Avoiding Hypothermia and Winter Injuries

In cold weather, our bodies try to keep a warm inner (core) temperature to protect our vital organs. They do this by slowing blood circulation in our face, arms, hands, legs, and feet. The skin and tissues in these areas becomes colder. This puts us at risk for frostbite. If our core body temperature drops just a few degrees, hypothermia will set in. With even mild hypothermia, our brain and body don’t work as well. Severe hypothermia can lead to death.

Frostbite and hypothermia can occur at the same time. The early stage of frostbite is called frostnip. Signs include

Red and cold skin; skin may start to turn white but is still soft

Prickling and numbness

Tingling

Stinging

Early-warning signs of hypothermia include feeling cold, shivering and signs that the cold is affecting the body and brain, such as stumbling, mumbling and confusion.

We need both food and fluids to fuel our body and keep us warm. If we skimp on either, we increase our risk for cold-weather injuries such as hypothermia and frostbite. Eating foods with carbohydrates gives us quick energy. Even if only out for a short time, carry a snack bar to keep your energy going. If out all day skiing, hiking, or working, be sure to bring food with protein and fat as well to fuel you over many hours.

When shoveling or lifting outdoors, take a few minutes to stretch. Shoveling snow is a workout, so we need to stretch to warm up our muscles, similar to when we work out at the gym. Stretching before shoveling will help prevent injury and fatigue.

Also, push don’t lift. When we push the snow to the side rather than trying to lift the snow to remove it, we exert less energy and place less stress on our body. If you must throw snow or ice, take only as much as you can easily lift and turn your feet to the direction you’re throwing – don’t twist at the waist. Do not throw snow over your shoulder or to the side, and pace yourself. Shoveling snow is strenuous activity comparable to weightlifting while walking on uneven and unstable ground and wearing heavy-duty clothing.

Drink plenty of fluids before and during activities in the cold. We may not feel as thirsty in cold weather, but we still lose fluids through sweat and breathing. Bring an abundance of water or sports drinks when recreating outdoors, and try to avoid caffeine or alcohol – both actually dry us out, instead of hydrating, and alcohol lowers body temperature.

And finally, remember to wear sunscreen – the sun’s ultraviolet rays remain potent, even in the winter, and hydrating our skin with a UV-protective moisturizer will help protect us from wind and other elements.

Vitamin D is a critical building block for ensuring strong bones and helping prevent or mitigate a variety of diseases that affect us as we age. Vitamin D helps our body absorb calcium, one of the main building blocks of bone. Vitamin D also plays a role in keeping our nervous, muscle, and immune systems healthy.

We can get vitamin D in three ways: through our skin, from our diet, and from supplements. Our body forms vitamin D naturally after exposure to sunlight. But too much sun exposure can lead to skin aging and skin cancer, so many people try to get their vitamin D from other sources.

It’s important to take steps now so that bones will be healthy and strong throughout our lifetime. That’s especially critical in the childhood and teen years to avoid osteoporosis and other bone problems later in life. Osteoporosis is a condition in which bones become softer and fragile, making them fracture or break much easier.

We build strong bones by getting enough calcium and weight-bearing physical activity during the tween and teen years, when bones are growing their fastest. Young people in this age group have calcium needs that they can’t make up for later in life. In the years of peak skeletal growth, teenagers build more than 25 percent of adult bone. By the time teens finish their growth spurts around age 17, 90 percent of their adult bone mass is established.

The Role of Calcium in Building Healthy Bones

Our body continually removes and replaces small amounts of calcium from our bones. If it removes more calcium than it replaces, our bones will become weaker and have a greater chance of breaking. By getting lots of calcium when we’re young, we can make sure our body doesn’t have to take too much from its bones, where calcium is stored. After age 18 we can only maintain what is already stored to help our bones stay healthy.

Calcium is found in a variety of foods. Low-fat and fat-free milk and other dairy products are great sources of calcium. Tweens and teens can get most of their daily calcium from three cups of low-fat or fat-free milk, but they also need additional servings of calcium to get the 1,300 mg necessary for strong bones. In addition:

Low-fat and fat-free milk has lots of calcium with little or no fat

The calcium in low-fat and fat-free milk and dairy products is easy for the body to absorb and in a form that gives the body easy access to the calcium

Low-fat and fat-free milk has added vitamin D, which is important for helping our body better absorb calcium

In addition to calcium, milk and dairy products provide other essential nutrients that are important for optimal bone health and development.

Other good sources of calcium include dark green, leafy vegetables such as spinach, broccoli and bok choy. There also are foods with calcium added, such as calcium-fortified tofu, orange juice, soy beverages, and breakfast cereals or breads. Adults or youth who can’t process lactose can take calcium supplements but should check with their physicians to ensure compatibility with other medicines or conditions.

Bones are living tissue. Weight-bearing physical activity causes new bone tissue to form, which makes bones stronger. This kind of physical activity also makes muscles stronger. When muscles push and tug against bones during physical activity, bones and muscles become stronger. So there’s much we can do at any age to ensure strong, healthy bones, but it begins with awareness, and is fortified through diet and physical exercise.

Warning Signs of Vitamin D Deficiency

Vitamin D deficiency can lead to a loss of bone density, which can contribute to osteoporosis and fractures. Severe vitamin D deficiency can also lead to other diseases. In children, it can cause rickets. Rickets is a rare disease that causes the bones to become soft and bend. African American infants and children are at higher risk of getting rickets. In adults, severe vitamin D deficiency leads to Osteomalacia, which causes weak bones, bone pain, and muscle weakness.

Additionally, researchers are studying vitamin D for its possible connections to several medical conditions, including diabetes, high blood pressure, cancer, and autoimmune conditions such as multiple sclerosis.

Some people are more prone to vitamin D deficiencies. They include:

Older adults, because skin doesn’t make vitamin D when exposed to sunlight as efficiently as when we were young, and our kidneys are less able to convert vitamin D to its active form

People with dark skin, which has less ability to produce vitamin D from the sun

People with disorders such as Crohn’s disease or celiac disease who don’t handle fat properly, because vitamin D needs fat to be absorbed

People who are obese, because their body fat binds to some vitamin D and prevents it from getting into the blood

People who have had gastric bypass surgery

People with osteoporosis

People with chronic kidney or liver disease

People with hyperparathyroidism (too much of a hormone that controls the body’s calcium level)

People with some lymphomas, a type of cancer

People who take medicines that affect vitamin D metabolism, such as cholestyramine (a cholesterol drug), anti-seizure drugs, glucocorticoids, antifungal drugs, and HIV/AIDS medicines.

How to Get More Vitamin D in Our Bodies

There are a few foods that naturally have some vitamin D. These include

Fatty fish such as salmon, tuna, and mackerel

Beef liver

Cheese

Mushrooms

Egg yolks

We can also get vitamin D from fortified foods. Food labels list whether a food has vitamin D. Foods that often have added vitamin D include

Milk

Breakfast cereals

Orange juice

Other dairy products, such as yogurt

Soy drinks

Vitamin D is in many multivitamins. There are also vitamin D supplements, both in pills and a liquid for babies. If you have vitamin D deficiency, the treatment is with supplements. Check with your health care provider about how much you need to take, how often you need to take it, and how long you need to take it.

Getting too much vitamin D (known as vitamin D toxicity) can be harmful. Signs of toxicity include nausea, vomiting, poor appetite, constipation, weakness, and weight loss. Excess vitamin D can also damage the kidneys. Too much vitamin D also raises the level of calcium in our blood. High levels of blood calcium (hypercalcemia) can cause confusion, disorientation, and problems with heart rhythm.

Most cases of vitamin D toxicity happen when someone overuses vitamin D supplements. Excessive sun exposure doesn’t cause vitamin D poisoning because the body limits the amount of this vitamin it produces, but as mentioned earlier, too much sun exposure can lead to skin cancer and premature aging, so moderation is important.

Talk with your health care provider if you are at risk for vitamin D deficiency. There is a simple blood test which can measure how much vitamin D is in our body. Take steps now to ensure strong bones and better health later in life, essentially through a proper diet and exercise.